Hurts So Good

Chapter One

FROM THE TOP

SARAH LONDON TIPS HER PRETTY FACE UPWARD TOWARD MY CAMERA, flashing her spit-slick mouth guard for a photo op. It’s white with pink roses; in cursive script, it says Bitch, please. Her words are clunky around the soft molded plastic protecting her teeth. She tells me that in her first fight, which she lost, she was pummeled hard by a much more experienced competitor, and her mouth guard filled with blood. Moments before she tells me this, amid the intimacy of sparring bodies and the myriad aromas that come with such engagements, she had burst out laughing and squealed, “No no no!” as someone threw her down hard onto the mat. “I don’t give a fuck about getting hit in the face,” she tells me with a sly grin. “The body, I mind. But not the face.” Pain does different things to different people.

Sarah is a Muay Thai fighter. We used to dance ballet together, but now I’m perched atop a cinder-block wall in the basement of a building in East Nashville watching her spar. Neither one of us dances anymore, not like that. It appears we have both found new ways to scratch our old itches.

I’ve come to see Sarah because it is impossible to talk about my own relationship with masochism without bringing up my decades in ballet. Wading into these memories feels like high-stepping through a thatch of blackberry brambles with bare legs and uncalloused soles: it hurts, though there is sweetness there too. Mostly, it just makes me want to swear a lot. When I asked Sarah if she missed ballet, she gave an immediate and resounding no.

The ballet world, as I experienced it, was inordinately physically and emotionally abusive, a mass of concentric circles of hush-hush hell. It was years spent cowering and starving, eternally at war with my poor, battered body, which featured breasts that resolutely refused to get smaller, no matter how small the rest of me got. It is vastly unpleasant to recall those days, though my suffering did nothing to stanch my devotion to the art form back then. If anything, it strengthened my resolve. Ballet swallowed my entire childhood and adolescence; hours of dancing after school each day gave way to leaving home for a residential conservatory program in high school. I spent whole summers at weeks-long intensives. Ballet consumed me in a way that nothing else ever has, or ever will. I loved it desperately. I know she did too.

I bring this up because I am constantly trying to answer the impossible question of why, exactly, I am the way I am. Why I like to choose pain. Specifically, did ballet make me a masochist? Or was I simply well suited to the grueling discipline of the art form because of something intrinsic to my core personality, the nebulous you-ness that becomes solid and nameable by kindergarten? (Two things can be true at once, and my guts tell me that the answer to both of these questions is yes.) When it comes to my complicated relationship with pain, I used to feel the kind of shame that gets yoked to a sense of uniqueness, like my burden was mine and mine alone, but I don’t anymore. Now I see that hurting on purpose to feel better is no novel thing. It’s everywhere, inside of hot sauce bottles, lurking in cold pools, dripping onto studio floors, and wafting through the air in the Nashville MMA gym where Sarah is trading kicks to the rib cage with her boyfriend. If this book has taught me anything, it’s that I’m not special. Truly, a comfort.

Part of the not-specialness stems from the basic, shared biology of a healthy human body. For the most part, our bodies all do the same thing when it comes to processing and feeling pain; the similarities in mechanics create the universal experience of OUCH. It goes a little bit like this: When someone stands en pointe, their entire body weight pouring into the tips of their toes, the body sounds an alarm. It’s the same as when a person takes a well-muscled shin to the outer thigh, as Sarah’s legs are turning red in protest of: the body responds, and loudly. The nervous system fires strong and clear, with nerve cells called nociceptors rushing the alarm up to the brain, the electric current that is the message zipping along the wet noodles of our sensory apparatus. In response, the brain must take into consideration the context of the signal and creates a symphony of pain that is shaped by things like emotional state, level of surprise, and previous history of such events. From here, the body releases many signals and chemicals, including its own homebrew morphine, thanks to the endogenous morphine system. You see, endorphin is a portmanteau of “endogenous” and “morphine.” The drugs are coming from inside the house.

It is generally understood that endorphins feel good, and they get you high. So, when I talk about feeling bad to feel better, I mean it very literally. Pain can lead to feel-good chemicals and I, like so many people, am all too willing to exploit this fact for my own benefit.

On the mats before me, Sarah takes a knee to the side of her body and winces, giggles. Otherwise, her face is a placid sculpture of concentration. She tells me that they make fun of her for laughing when she gets hurt, but I get it. We were both taught how to push through pain and how to derive pleasure from it.

Sarah and I started dancing together in middle school. We were both apple-polishing baby ballerinas with fastidiously concealed streaks of mischief. We stood in class near each other, holding the backs of our thighs apart so our legs looked skinny in the mirror, sweating and heaving through hours and hours of classwork. When we weren’t mimicking pristine dancing robots, we smoked pilfered cigarettes and stayed up all night to learn Ludacris lyrics, like normal hormonal wildlings.

There is something about the cult of ballet that is hard to impart to an outsider. I can very easily describe to you how terrible it was at times: the drunk ex–New York City Ballet principal dancer who hurled a chair at me, the man who threw me out of class repeatedly because he was disgusted by my brand-new teenage breasts, the director who pretended to expel me from my prestigious boarding school because he wanted a good laugh at my tears. I can tell you about the dancers who passed out during sweltering classes in the bowels of a Manhattan summer intensive and how we were instructed to just roll them out of the way and keep going. The horrors, those are easy to share.

But the good things? The things that kept me coming back over and over again? Intangible, transcendent, addictive. And ultimately, for me, for a long time: worth it.

The next day, Sarah scoops me up from the gym where she works to take me to an all-but-abandoned mall where she trains Muay Thai. I follow her down a graffitied corridor, her extra-large, neon-green gear bag dwarfing her petite but tautly muscled body, giving the impression that I am trailing a really buff, adorable turtle. The hallway opens into the mall, which is almost entirely empty, save for a quinceañera supply store and Chonburi Muay Thai. The mall is closing entirely, forever, in two weeks, and some of the stores left trash and old merch behind in the haste of their exits. The bathrooms do not work, but I hear there is still a functional food court. I am too interested in the bodies warming up on the floor to go do any exploring. The remnants of a retail clothing shop line the walls of the gym (you know, those little metal bars that shelves hook into?), and there’s a Pepsi cooler filled with bottled water and a half-empty two-liter of Coke. The mats are shaped like jigsaw pieces and fit together neatly.

“It’s just like ballet,” she tells me, her purple hair pulled back into a ponytail. “You learn the choreography and you get hurt doing it. It’s the exact same thing.” And with that, she’s off to do warm-ups with her boyfriend, who is also a Muay Thai fighter. The two of them lie on their backs on the mat, swinging their legs in wide circles, loosening their hips in unison. Both of them are densely muscled, compact, which seems to be the trend among many of today’s class participants. When Bruce, the instructor, comes over to introduce himself, shaking his hand sends sparks of alarm up my arm. It feels like it is entirely made of wood. I’ve never felt a hand like this before. It is just completely and unmistakably solid. When I tell Sarah this, she laughs. She knows.

As promised, the class really is just like ballet, with a few aesthetic differences. The clothes are tight, but there is no mirror. Bruce calls out combinations not of pliés and tendus, but of kicks and punches, and the room obeys; one person striking, one person holding the pads, then they switch. All exercises are completed on both sides of the body, for equal muscular development. The combinations escalate in intensity, starting slowly, then pushing through a sweaty corridor of pain and resolve. When the students learn new moves, there is an inevitable awkward period, as their bodies figure out how to mimic the necessary motions, coolly juxtaposed with the immediate grace of the instructor. The familiar pattern of a fumble, followed by the thrill of success. The students sharply perform their tasks but without the monastic silence of ballet class. Instead, some of them grunt and shout “ooh wee” to acknowledge a hit, their faces deep in concentration. The thud of the pads is incredibly satisfying, and I have little doubt that Sarah could break a few of my ribs with a single kick. She gets a cramp in a butt muscle and frowns, rubbing it out with a gloved hand. I laugh to myself. I watched her do this move twenty years ago in the mirrored halls of the North Carolina School of the Arts. The similarities between the art form we grew up devoted to and the activity unfolding before me are staggering. The secret language of the discipline, the ritualized movement of the group, the perfuse sweating: it all makes me intensely and immediately nostalgic for ballet class. Only this is ballet class without mirrors. This is ballet class with hitting.

I watch Sarah out there working her ass off. She’s a gifted physical mimic and a tenacious athlete, looking every bit in her element as she kicks and sweats and laughs through a hard strike to the shoulder. This laugh comes with a grimace, though. She stops and rubs it, wincing, garnering a hug from her sparring partner. As she works, little glimpses of her past come through; the way she sharply keeps her weight on the balls of her feet and out of her heels, the ease with which she bends over to stretch her hamstrings and rolls up through her spine to standing, small tells that only a fellow dancer would likely notice. She gently kicks a much taller man in the head, and he smiles at her.

At the end of class, they do conditioning, which is to say they kick each other a bunch to get tougher. First, the blows land on the outer thighs, right in the meaty expanse of the rectus femoris. Then, with arms up, the kicks move to landing on the side of the body. Bruce calls them love taps. Faces contort around the need to remain static, as if a curled lip or clenched jaw could mitigate the force of a padded shin on a tender rib cage. The pain, the sense of accomplishment, the endorphins, the sheer fun of cultivating an expansive willpower, I get it. I get why a talented dancer would find a home in combat sports. How healing it must be to take the internalized violence of ballet and turn it outward.

It looks like so much fun.

But isn’t that just why I came here? Sarah reflects back to me confirmation of my own reasoning about myself, how I got here, why I’m like this. We both danced intensely after we lost touch, and toiled mightily in the ballet realm. We both married young, with boring-to-bad first marriages that evaporated instantly once we started to become Actual People and not disconnected automatonic ballet survivors. We both spiraled out in the end days and aftermath of ballet. And we’ve both found ways to build back into our lives the facets of ballet that kept us in it all those years. The parallelism of our lives, revisited after twenty years of silence, is striking.

I look down to my lap and see that my shorts are riding up. Under the fluorescent light, the tops of my inner thighs are yellow and speckled with rings of mottled, purple bite marks. There are so many that the chaotic markings do not read as teeth. Even after I leave the gym, after I hug Sarah goodbye, I cannot stop thinking about how ballet shaped us both.

For me, ballet was formative in countless ways and no doubt helped deliver me to all sorts of masochistic hobbies in my adult life. And though, in my experience, dancers tend to be masochists, there are many, many other people who indulge in pain on purpose who have had no exposure to shiny satin torture shoes and shouting leotard-clad Russian women with long sticks and short tempers. But there’s no questioning that those shiny torture shoes changed my life.

I got my first pair of pointe shoes when I was twelve.

It was, without question, one of the most hotly anticipated milestones of my childhood, a source of great obsession and longing, going back as far as I can remember, and probably stretching beyond that too. Whereas many children focus their excited dread onto harbingers of puberty like warbling voice boxes and secret hairs, I was more concerned about when I would get my pretty torture shoes than when my breast buds would pop. I was monomaniacal in my pursuit.

It’s important not to start pointe work before the muscles are strong enough to stabilize the foot en pointe; pointe work too early can result in broken bones and lifelong damage. So I trained hard and often, both in class and in secret, doing relevés in my bedroom at night, in the shower, while I brushed my teeth, anywhere I could get away with the smooth, slow up and down of my body, heels pitching forward and back as my calves labored under strict orders. After eight years of dance classes and desperate prayer, it was finally time. My teacher gave me the blessing I’d waited for my whole tiny little life, and I ascended into clouds of pure elation.

It’s critically important for any pair of pointe shoes to fit perfectly but especially the first pair. For conventional pointe shoes, the hard box (where the toes are) is made of layers of cardboard and fabric, glued together kind of like papier-mâché. The shank, the hard underside of the shoe, is a piece of stiff leather. The rest of the shoe is like a soft ballet slipper. Feet work inside the shoe to roll up through tiptoes to standing, balancing on the big toe, closely clipped toenails perpendicular to the floor. (This mechanical motion of the foot and the need to use materials that will form themselves to the shape of the foot through use is why pointe shoes break down and must be replaced when they go soft.) There is no padding in the shoe, and neither ribbons nor elastic are sewn onto the shoe before purchase. The outsides are covered in satin, and my insides quiver to think of them, one of the few deep nostalgias from my youth.

The shoe itself represented the culmination of everything I had ever wanted in my just-over-a-decade of living, so even though I knew it was going to hurt, I was excited to get fitted. After all, a proper fit helps instill proper form. If the shoe isn’t perfectly snug, slipping and bagginess can destabilize the foot, leading to injury. If the shoe is too tight, the foot cannot be articulated, and the painful and often disfiguring art form of dancing en pointe is impossible. Teachers told me that padding makes it hard for dancers to feel the floors, their tone of voice implying that dancers who use it are somehow less. Some people use bits of lambswool or the more modern thin gel pads to cover the toes, but I was determined to be the kind of person who didn’t need it. I used snips of medical tape and sometimes a square of single-ply toilet paper, folded around my toes like a sheet of gift wrap. As you can imagine, I was a terribly relaxing child.

Finally strong enough and with child bones ossified enough, I stood waiting in the dark backroom of a decades-old dancewear shop next to the basket of clearance leotards from the 1980s and in front of a wall of dusty tap shoes and character heels. The stooped octogenarian motioned for me to sit, then took my feet in her hands, examining them closely for size and structure before taking some measurements and scuttling into the even deeper recesses of the store to gather boxes.

Squinting again at my feet, she asked me to stand and do some calf raises. She watched, assessing my body mechanics without comment, then complimented my teacher (not present) for her mindful assessment of my strength and readiness. Reaching into one of the boxes, she pulled out a pair of a peachy-pink Chacott Coppelia II pointe shoes and handed them to me. My blood pressure went nuclear with anticipation, hands tingling, chest flushing hot under the dim lights. Oh my god.

I slipped the satin fantasy objects onto my twelve-year-old feet, my toes bare except for makeshift socks cut from a pair of tights that bagged around my ankles. I stood flat-footed for her assessment. She pinched my heel, hooked her finger under the satin, and pressed the toe box before nodding toward the mirror. It was time.

I took my last invigorating steps as a pre-pointe student and stood on the mat at the practice barre. Fingers gingerly resting on the wooden support, I bent my knees and sprung to my toes, ankles solid, knees strong, fully finally on pointe. My breath caught hard in my chest, the sensation from my feet crashing into the realization that getting everything I dreamed of really would come at a cost. My desire for this moment was not enough to blunt the pain, which I’ll describe as what if you took your shoes off and kicked the wall with your big toe as hard as you could, over and over and over and over again, and then you kept doing it until your toenails turned eggplant purple and fell off? (Spoilers!)

I nearly blacked out from the pain, but I would be damned if I’d show an ounce of regret. I pliéd and relevéd again, going up and down and up and down and up up up up up. I smiled big, triumphant. My feet would hurt the rest of the day, the week, the month, just years of foot pain stretched out before me, but who cared? I was a fucking ballerina. I’d been allowed to join this very niche, very beautiful pain cult. I lifted one foot to rest under my knee en pase.

Mathematically, being en pointe on just one foot, with all one’s weight on the bony tips of the toes, represents a force of around 4,100 newtons per meter, which is equivalent to having the weight of an entire horse, or an entire grand piano, crushing down on a single pointed toe. I have heard from dancers and doctors alike that, to the uninitiated, the pain of standing en pointe is enough to make a person pass out.

And there I was, initiated and absolutely fucking giddy for it.

I took to pointe work with rapt enthusiasm, regularly bloodying my toes practicing relevés late at night in my bedroom, muting the tap-tap-tap of my magic shoes with carpet and sweaters so as not to draw attention to my nightly ritual. It wasn’t the pain that I loved; to be honest, it really fucking hurt. I cried, a lot. But the crying, I did that alone. Ballet is supposed to be beautiful, and I wanted that beauty for myself. Every time I danced en pointe, I felt bad, and then I felt better.

My pointe work improved too. While my poor feet regularly turned into raw hamburger, toenails falling off, blisters bursting open and weeping, strange round calluses pushing proudly up from my softness, my ability to regulate my response to the pain got stronger. I could dance through pain, bleed through my pretty pink pointe shoes, rehearse well past dinnertime and into the dark of evening, only to wake in the night when my bedsheets ripped away fresh scabs from my oozing feet stuck to floral printed cotton-poly blend. The only shoes I could stand to wear, outside of the pointe shoes themselves, were flip-flops. It hurt too much to peel socks off, and if I was going to be in the studio from one till eight, I needed to air out my wounds as much as possible. I went to a ballet boarding school for my later years of high school, but we did our academics in the morning at the local public high school, so my non-ballet classmates were regularly treated to a full view of my bloody feet.

By the end of my career, I’d danced through missing toenails, broken bones in my feet, a torn rotator cuff, tendinitis so bad that my ligaments began to tear, head trauma from getting kicked under the chin while onstage, and a back spasm so severe that it cracked one of my lumbar vertebrae. All of it hurt. But I kept at it. It’s not that the pain went away, just that my tolerance for it was bolstered by my desires and complimented by my superiors. In hindsight, I wish I had been less reckless and punitive with my body.

The freakish tolerance for the pain in my feet thing didn’t really go away after I quit ballet. Years later, at a party, one of the hosts mentioned that she had a pair of ballet boots for photo shoots. She couldn’t even stand in them, much less walk in them, but she said that I was welcome to try on the fetish item if I so desired. At this point I was in my early thirties, nearly a decade away from my once-beloved pointe shoes (for the ballet dancers and ex-ballet dancers who are reading this, my go-to shoes were Grishko 2007s, super-soft shank), but old habits die hard, and I was more than willing to try the boots on. First, I stood in them. Exquisitely painful, as promised. Then I took a lap around the room for old time’s sake, feeling my toenails bruise in real time. Still got it.

But, my god, I must confess: in spite of all that, when I stub my toe, I cry.

How can this be? How is it that I could be so tough, such a belligerent taskmaster to my own body, my own feet, and yet I tolerate an unexpected table leg to the big toe with no more grace than any other random barefoot wanderer? Pain, on some level, feels so intuitive, so knowable. Of course I know what pain is, we say. Pain is when something hurts. But what is it really? Sure, we know it when we feel it. It feels obvious, immutable, a universal constant akin to death and taxes.

But it’s not. Pain is an entirely subjective experience, each and every time, cooked up fresh by a brain eager for gossip of the outside world and desperate to stay safe within it. What’s going on? Have I felt that sensation before? Am I in danger? Am I hungry, sad, aroused, or tired? Angry? What do I expect to happen? What can I see, what can I smell, what can I hear? Any threats? How do I contextualize the data coming in from the nociceptors? Is it time to sound the alarm or time to chill? Is there tissue damage happening? Could there be tissue damage happening? Oh my god, am I safe? Am I going to continue being safe?? Could I be safer??? The brain asks these questions—and so, so many more—and then, using all the information it has gathered up and assessed, creates the experience of pain as it sees fit.

Pain is no simple thing. It’s not a switch that gets flipped, on/off. It’s more like a frog in the swamp of your conscious mind, adding its voice to the chorus of all the other sounds jockeying for position. Only sometimes, this frog can make a sound that blasts through everything else like a fucking foghorn. Like vision, taste, and hearing, pain is another easily persuaded sensory experience from the wilds of your perceptive and reactive facilities. Pain can mean danger, but pain itself doesn’t necessarily mean that the body is in danger. And a lack of pain doesn’t necessarily mean that the body is unharmed. Pain can be acute, chronic, diagnostically relevant, diagnostically irrelevant, enduring, incapacitating, boring, maddening, used for fun, and wielded in pursuit of some of the greatest atrocities ever committed by humankind. Pain keeps us safe. Pain ruins lives. And the more closely I examine it, the more questions I have. What do we really know about pain?

There is no way to know exactly how much someone hurts. As of yet, there is no method for quantifying how much pain a person has without asking them, no numeric score that an outsider can assign, no way for a laboratory technician to divine the painful truth through chemical reagents and whirring centrifuges. There are no tests doctors can do to examine the “pain” part of the brain. There is no single pain part of the brain.

Each individual painful experience is created based on a slew of factors and can be hard to predict. As we’ll see below, the experience of pain is always subjective, crafted by the mind itself and subject to all kinds of outside influences, including anxiety, threat level, emotional state, previous memories, degree of anticipation, and sexual arousal. Our inner life and our surroundings not only affect the experience of pain, they inform it and are critical to the creation of the sensation.

So… what is pain?

Dr. Lorimer Moseley stands on a small stage at TEDxAdelaide for his talk, “Why Things Hurt.” He seems at ease, making jokes with the crowd in his Australian accent, wearing black jeans and a slate-blue button-down. Shirt slightly unbuttoned, face slightly stubbled, head shaved. “I want to tell you a story that will explain to you the first three years of the neurobiology of pain that you would study at university.”

The story begins with our Moseley walking in the bush, which he mimes across the small stage. He is a senior principal research fellow at Neuroscience Research Australia (NeuRA), and his work with chronic pain treatment is revolutionizing patient care. As he reenacts that fateful stroll through the Australian wilderness, there is a nearly imperceptible disruption of his gait, kind of like the walking version of a hiccup. It’s so slight that he does it again, making sure we see it.

“Biologically, I’m going to tell you what happened just then,” he says, referencing the small skip in his motion. “Something touched the outside of my left leg in the skin. That activates receptors on the end of big, fat, myelinated fast-conducting nerve fibers, and they stream straight up my leg, like whoosh,” he says with an onomatopoeic flair. The signal enters his spinal column, then whooshes again up to the brain, where it delivers its urgent message:

“You’vejustbeentouchedontheoutsideofyourleftlegintheskin.”

Moseley intones the sentence as a breathless single word, much to the delight of the crowd. The human body is covered with these intrepid messengers, and the fast ones are ON IT when it comes to being touched. If something makes contact with the meat sack, Brain simply must know about it. Safety first!

On that walk in the bush, whatever stimuli activated Moseley’s fast myelinated fibers also activated his slower free nerve fibers, the nociceptors. But, on that fateful day, these messages went unheeded.

“[The message] gets to my spinal cord, and that’s as far as it goes. And it says to a fresh neuron in my spinal cord, ‘Ahhh, you’ve just been, um, something dangerous has happened on the outside of your left leg in the skin… mate.’” This time Moseley delivers the message in a laid-back drawl befitting the unmyelinated fibers it rode in on. And so, he continues, the spinal nociceptor takes the message all the way up to the thalamus, nonchalantly notifying it of danger on the outside of the left leg. This signal isn’t traveling on myelinated fibers like the fast one was, so it’s coming in more slowly.

Now it’s brain time. Moseley tells the crowd that, at this point in the process, the mind must assess how dangerous the whole situation really is. To do this, “it looks at everything.”

His brain asks itself, Have we been anywhere like this environment before? Well, yes, of course, he has been hiking in the bush before. Building on that, his brain checks for any memories of similar sensations happening on his lower leg while walking in such an environment. Has that happened before? Of course it has; such little scrapes are part and parcel of hiking in a sarong.